This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Wednesday, February 12, 2014

E-Health Excitement Is Running Rampant Out In The Central West Of NSW. Journalists Are Pushing Hard As Well!

Western NSW Medicare Local (WML) and Narromine Shire Family Health Centre are encouraging residents in the town and surrounding communities to register for a Personally Controlled Electronic eHealth Record (PCEHR) by holding a registration day tomorrow.

WML staff will help register community members for a free eHealth record with doctors then uploading a summary of their health information into the system.

"Any visitors can attend the registration day and get an eHealth record and have their own GP upload their health summary later," a WML spokeswoman said.

An eHealth record is an electronic summary of a patient's key health information drawn from their existing patient records. Information can be uploaded by an authorised healthcare professional which is typically a person's regular GP.

Information that can be uploaded includes medications, test results, discharge summaries, allergies and details of any immunisations.

Narromine Shire Family Health Centre GP Dr Kumara Mendis reports of its doctors seeing the benefits of the Narromine community registering for an eHealth record

"Having a central online location where patients can control and access all their health information, is a great advantage for the public and doctors in the community," he said.

"Doctors will be able to see their patient's medical history and test results from all the different health services that the patient visits. "This registration day will help anyone in the community take ownership of their medical history."

WML deputy chief executive officer Stephen Jackson said it had been promoting meaningful use of the eHealth record system across the region.

Narromine residents are invite to register for a Personally Controlled Electronic eHealth Record at a registration day tomorrow at the Narromine Shire Family Health Centre at 9am.

Western NSW Medical Local (WML) will be helping and registering community members for a free eHealth record and the doctors will be able to upload a summary of their health information into the system.

Any visitors can attend the registration day and get an eHealth record and have their own GP upload their health summary later.

A eHealth record is an electronic summary of a patient’s key health information drawn on existing patient records.

Information can be uploaded by an authorised healthcare professional which is typically a person’s regular GP. Information that can be uploaded includes medications, test results, discharge summaries, allergies and details of any immunisations.

The centre doctors see the benefits of the Narromine community registering for an eHealth record according to Dr Kumara Mendis, GP at the Narromine Shire Family Medical Centre.

eHealth Registration took place at the Narromine Shire Family Health Centre yesterday as locals flocked to sign up to the electronic health registration run by Western Medicare Local (WML) and Narromine Family Health Centre.

WML staff were thrilled with the turnout with more than 35 people signing up.

Narromine Men’s Shed members John Lenehan and Les Farr made their way to the health centre during a work break at the shed.

Both men said there was no harm in signing up.

“There’s a record of your medication, so if I’m in a car accident or something, the doctors will know my medications,” Mr Lenehan said.

Bernard, you can't really think that you're the first person to think of this? in fact, even the patient themselves telling you that they take something doesn't mean they do, or intend to, or take it right

But knowing that something is prescribed is a *huge* step up from not knowing that it was prescribed. Irrespective of any uncertainty around the execution or even correctness.

It doesnt say much for the state of journalism in Health IT, does it. It's astounding to me that some other things just go unreported.

In NSW the obvious one is WHY the state has employed as there temporary CIO the very person who set up and led the $350M HealthSmart program in Victoria to such disaster.

Why are they paying $2000 a day for a proven failure, plus the cost of flying her in from Auckland every week. Don't they know she is making them a laughing stock down here in Melbourne? And I doubt the hard-working staff in the NSW department are delighted either.

"Has this scenario ever been tested with health professionals?" - yes, at length. It's a pretty obvious thing to do.

Not that there is consensus about it. A rough rule of thumb is that anytime you ask a bunch of doctors something, you'll have more opinions than doctors in the room. Still, most of them agree that the this is a worthwhile concept - I think you would too, if you had ever been faced with an unconscious patient and *no knowledge at all*.

However I think most people would regard the liability issues as unresolved.

But with the PCEHR and medications, there are issues when considering the data quality of the medications components:• There have been errors in the PBS claims data sourced from the PBS information held by Medicare, which makes people (doctors and their patients) suspicious of the quality of this data.• Health summaries entered by providers (with medications information) may not be current (i.e. a new medication may have been added or stopped and no new summary is made available).• The information sourced from the new ETP prescription hubs (electronic prescriptions and dispensing information) will only be there (in the PCEHR) if the consumer decides to put it there, and if all of their prescribing GPs/doctors and all of their dispensing pharmacists are participating in both ETP and the PCEHR. If patients get their medications from multiple pharmacies or visits more than one GP/Specialist, then perhaps only some medications will be listed.Given this lack of data quality, I wonder if the presence of this information on the PCEHR is of any worth at this point of time. I agree with Bernard that it may just create another confusing silo of information. And the problem of it not being worthy of consideration is that people will not use the system. But they might use it if they were more informed about the data quality for each item.Improving on this situation would require:• Data governance: cleaning up the PBS data (which means all the business processes right down to the pharmacy dispensing counter) and convincing people that it can be now be trusted.• Ensuring that health summaries are current and available for consumers who have registered for a PCEHR – perhaps chronic conditions and aged care consumers should have a new summary done at specified times (every 3 months?) or when significant changes occur (e.g. a new medication is prescribed). • Making sure that everyone is aware of the current quality and limitations of the ETP/prescriptions hub sourced data in the PCEHR. It is anticipated that the data quality (accuracy, completeness etc) will increase over time we hope, but right now it cannot be relied on without knowing its limitations.• Fixing up the personal access control model for the PCEHR, including ensuring who can see which parts of a record and when. This needs to be simple and transparent for consumers and for health care organisations. It is an incomprehensible mess at the moment.Given all of that, perhaps it would be good for the PCEHR program to step back and focus on one area to see how it could be very effective. Aged care nursing homes would be a good pilot. Having a reliable new summary of information loaded each time a resident’s medication changes and also knowing when they took their last doses would make a big difference when they arrive in the ED in the middle of the night. This is where the PCEHR could shine, gather momentum and trust and then be extended to other areas. Surely they are considering this already in the review of the PCEHR.

An even simpler approach would be to have the PES Hubs working together to maintain one current medicines record. As they are now interoperable surely it's not rocket science to keep one record current. Is it?

Although for that to work the government would have to discontinue with its National Prescription Dispense Repository - NPDR - which is full of inaccurate useless rubbish.

But then, it might be too difficult for the bureaucrats to embrace this idea because as they so often say, in response to a good idea: "oh, we couldn't do that because it would set a precedent".

Re the earlier post: I don’t have any strong view on Fiona Wilson, although I agree on the face of it that it seems a “brave” decision to have her involved in anything at a state level given the patchy track record of HealthSmart.I’m more interested in the earlier poster’s comment as to how come this hasn’t made the press or attracted more comment. I agree there’s a story there – whether that’s a story about the triumph of an individual overcoming the unfair reputational damage that went with managing a big program, or a story of a government department hiring a known dud, I’ll leave to others to judge.The point that the earlier post really made me realise was this: I’m sick of reading about the PCEHR.It’s yesterday’s news, and I find many of the comments are starting to sound like arguments about the angels on the end of the pin. Dry and ultimately fruitless.I want to hear about how the EPAS system in SA is really going, and about how QLD are going with Cerner, plus how is Fiona Stanley going out in WA?I don’t mean to be too critical of the great effort that goes into this blog, but I wonder if others feel as I do? The PCEHR is dead. Let’s move on.

This is precisely the attitude and mentality that enables incompetent bureaucrats to get away with wasting over $1B of Taxpayers money without any accountability!

Let's not move on until those responsible are held to account, and hopefully dangling from the gallows as an example and deterrent for future bureaucrats NOT to treat Taxpayers money with contempt ever again!

The health sector and budget cannot afford this level of incompetence and wasteful largesse...